“It’s An Ethics/Legal Thing”: Responding To Maladaptive Coping ANISSA HOWARD, PHD, LPC, LMFT, NCC, RPT-S
Play therapists working with children and adolescents who exhibit maladaptive coping skills must act with immediacy to help youth and their parents effectively address such behaviors. Maladaptive coping strategies implemented to help an individual deal with a stressful event (McLafferty et al., 2019). Examples of maladaptive coping skills include and are not limited to underage
drinking, substance abuse, and non-suicidal self-injury. Parents should be informed if their child is engaging in behaviors that are harmful or potentially life threatening. Therapists have ethical and legal obligations to their clients and must adhere to safeguards to ensure their safety. Parents trust that therapists will act in the best interest of their minor children and often expect that the therapist communicate concerns around harmful behaviors (Kress & Paylo, 2019). Parents should be able to assume that therapists, when necessary, will enact safety measures that promote client safety in accordance to presenting circumstances. This includes informing parents when client behaviors are not life- threatening, but serious enough to warrant a shift in clinical focus. A shift in clinical focus means that the client, parent, and therapist should reconvene to discuss the implications of the shift as well as safety/ crisis planning and psychoeducation. An effective therapist approach to addressing maladaptive coping skills is one that has a healthy mix of responsivity and ethical soundness.
those of legal and ethical expectations. This includes special attention information that is shared or withheld from others (Remley & Herlihy,
COUNTER POINT
relationships (Kress et al., 2019). Unfortunately, when considering of determining just how much privacy should be afforded and to maladaptive coping, therapists must act in accordance with legal and ethical obligations for client safety while utilizing clinical judgement on the client’s preference for the following options: (1) Therapist assisted disclosure of maladaptive coping skills to parent/guardian or (2) Sole therapist disclosure of maladaptive coping with client permission to parent/guardian. Both strategies, when implemented appropriately,
will have an opportunity to make informed decisions around sharing and disclosing information. Parents and youth can be involved in conversations around disclosure preferences and ways to handle certain topics. This includes maladaptive coping. Clients and parents in the event for the need to disclose, all parties involved are aware of the implications of the disclosure. Prior to the start of the counseling relationship, therapists should work with youth and parents/guardians to clarify the counseling relationship as well as other aspects of the counseling relationship (Kress et al., 2019). In doing so, all parties will
assessment tools for suicidal screening such as the Columbia-Suicide Severity Rating Scale (C-SSRS) paired with qualitative assessments (interviews, mental status examinations) to determine the level of threat substance use or suicidal ideation posed to the youth’s health. These therapists also described assessment of family systems and available social supports as contributing factors to whether involving outside systems made sense and warranted a decision to break the child’s
Children will seek to cope in a variety of ways which may include behaviors that are maladaptive yet serve an important purpose for the child. Self-harming behaviors can serve to express intense emotions, validate feelings, and create a visual representation of the pain (Taylor, Simic & Schmidt, 2015; Walker, 2012). Some children who self-injure may do so to cope with feelings of dissociation or depersonalization, helping themselves feel real or alive, which is especially relevant for people who
feel numb because of depression or trauma (Danylchuk & Connors, 2017). Experimentation with or ongoing use of substances is often regarded as a normative adolescent rebellion or a common experience (American Academy of Child and Adolescent Psychiatry, 2018). Many play therapists cite developmental norms, age considerations, and parents or guardians. Play therapists may assess the family system and whether that system would be likely to respond negatively. Therefore, the play therapist’s knowledge of family reactivity is included in their analysis for disclosure to ensure that disclosure does not increase the safety threat in the home.
Ultimately, there may not be a clear rubric for when to break
child client relies on a multifaceted and complex decision-making process.
www.a4pt.org | September 2022 | PLAYTHERAPY | 17
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